How Reliable Are Administrative Data for Capturing Stroke Patients and Their Care

Porter, Joan; Mondor, Luke; Kapral, Moira K.; Fang, Jiming; Hall, Ruth

doi:10.1159/000449288

Cited by 65 publications

(62 citation statements)

References 25 publications

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“…A recent study from Ontario demonstrated that in inpatients who suffered a stroke, administrative data alone were able to identify those who had MRIs or CTs of the brain in over 90% of cases. 17 In contrast, in that study, administrative data were only able to identify transthoracic echocardiograms in approximately 40% of inpatients. 17 …”

Section: Discussionmentioning

confidence: 79%

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Validation of billing code combinations to identify cardiovascular magnetic resonance imaging scans in Ontario, Canada: a retrospective cohort study

et al. 2018

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ObjectivesCardiovascular magnetic resonance (CMR) imaging is the gold-standard test for the assessment of heart function. Despite its importance, many jurisdictions lack specific billing codes that can be used to identify patient receipt of CMR in administrative databases, limiting the ability to perform ‘big data’ CMR studies. Our objective was to identify the optimal billing code combination to identify patients who underwent CMR using administrative data in Ontario.DesignRetrospective cohort study.SettingQuaternary care academic referral centre in Ontario, Canada.ParticipantsWe tested all billing code combinations in order to identify the optimal one to determine receipt of CMR. The reference gold standard was a list of all cardiothoracic magnetic resonance scans performed at Sunnybrook Health Sciences Centre between 1 January 2014 and 31 December 2016, verified by chart audit. We assessed the diagnostic performance (accuracy, sensitivity, specificity, positive predictive value and negative predictive value) for all code combinations.ResultsOur gold-standard cohort consisted of 2339 thoracic MRIs that were performed at Sunnybrook Health Sciences Centre from 1 January 2014 to 31 December 2016. Of these, 2139 (91.5%) were CMRs and 200 (8.5%) were chest MRIs. We identified the most accurate billing combination for the determination of patient receipt of CMR. This combination resulted in an accuracy of 95.3% (95% CI 94.4% to 96.2%), sensitivity of 97.4% (95% CI 96.6% to 98.1%), specificity of 86.4% (95% CI 83.1% to 89.6%), positive predictive value of 96.9% (95% CI 96.1% to 97.6%) and negative predictive value of 88.4% (95% CI 85.4% to 91.5%).ConclusionsOur study is the first to verify the ability to accurately identify patient receipt of CMR using administrative data, facilitating more robust population-based CMR studies in the future.

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Section: Discussionmentioning

confidence: 79%

“… 17 In contrast, in that study, administrative data were only able to identify transthoracic echocardiograms in approximately 40% of inpatients. 17 …”

Section: Discussionmentioning

confidence: 79%

Validation of billing code combinations to identify cardiovascular magnetic resonance imaging scans in Ontario, Canada: a retrospective cohort study

et al. 2018

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“…These codes have been previously validated at other Canadian academic teaching hospitals and have a positive predictive value above 89%. 19 For patients with more than 1 stroke during our study's time frame, we included only the results from their first admission for stroke. Patients who received tissue plasminogen activator were excluded from our study as these patients are admitted to the intensive care unit and then admitted to a neurology service, and thus not consistently captured in the GEMINI database.…”

Section: Study Populationmentioning

confidence: 99%

“…Of the 11 (0.9%) patients who had a cardiac thrombus, 5 already had an indication for anticoagulation (most often atrial fibrillation). For the remaining 6 patients, 5 were Prior stroke or TIA 243 (19) 139 24Diabetes mellitus 340 (27) 149 (25) Coronary artery disease 128 (10) 60 (10) Heart failure 73 626 4Antiplatelet use 396 (31) 215 (36) Anticoagulant use 141 (11) 75 (13) Note: SD = standard deviation, TIA = transient ischemic attack. *Unless stated otherwise.…”

Section: Echocardiographic Findingsmentioning

confidence: 99%

“…36 Third, we identified patients with stroke or TIA by their most responsible discharge diagnosis. Although the diagnostic codes we used have been validated in other Canadian hospitals, 19,37 we may have missed patients who presented with stroke-like symptoms but were subsequently given a different diagnosis. To account for this, we reviewed all patients with an initial diagnosis of stroke who subsequently had a different most responsible discharge diagnosis, and doing so did not identify any patients with patent foramen ovale or cardiac thrombus who were "missed" (Appendix 1).…”

Section: Limitationsmentioning

confidence: 99%

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Health Services

Fralick

Goldberg

Rohailla

et al. 2019

CMAJ

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S troke is the third leading cause of death in high-income countries, and accounts for substantial morbidity in those who survive. 1 Ischemic stroke is primarily due to a thrombotic or embolic event, and emboli frequently originate in the heart. 2 Transthoracic echocardiography can sometimes diagnose cardiac sources of embolism, such as atrial or ventricular thrombus, 3-5 and these generally require anticoagulation. Transthoracic echocardiography can also identify other causes of stroke that may require intervention, such as atrial abnormalities (e.g., patent foramen ovale, atrial myxoma) 6-8 or infective endocarditis. Transthoracic echocardiography is often recommended to plan secondary stroke management, but it is unclear how often this test provides clinically actionable findings. 4,9 Previous studies provide a range of conflicting estimates for how often transthoracic echocardiography might affect patient management because of changing opinions on what pathology is considered clinically relevant. 10,11 For example, dilated cardiomyopathy is no longer an indication for anticoagulation among patients with stroke. 12 Other findings previously considered to be incidental, such as patent foramen ovale, are now clinically actionable among patients with cryptogenic stroke. 6-8 Current stroke clinical practice guidelines do not reflect these nuanced data, making it challenging for physicians to know which patients should have transthoracic echocardiography after an ischemic stroke. 9,13,14 Furthermore, data that are both comprehensive and recent are lacking to further understanding of how often patients in routine care with stroke will have echocardiographic findings that are clinically actionable. Choosing Wisely 15 advocates against routine low-value care that is unlikely to improve patient care or is likely to cause harm. Transthoracic echocardiography is unlikely to cause direct patient harm but may cause indirect harm; for example, where incidental findings lead to invasive testing (i.e., transesophageal echocardiography) and expose patients to additional risks. Awaiting transthoracic echocardiography can also RESEARCH HEALTH SERVICES

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Derivation and Validation of ICD-10 Codes for Identifying Incident Stroke

Columbo,

Daya,

Colantonio

et al. 2024

JAMA Neurol

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ImportanceClaims data with International Statistical Classification of Diseases, Tenth Revision (ICD-10) codes are routinely used in clinical research. However, the use of ICD-10 codes to define incident stroke has not been validated against expert-adjudicated outcomes in the US population.ObjectiveTo develop and validate the accuracy of an ICD-10 code list to detect incident stroke events using Medicare inpatient fee-for-service claims data.Design, Setting, and ParticipantsThis cohort study used data from 2 prospective population-based cohort studies, the Atherosclerosis Risk in Communities (ARIC) study and the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, and included participants aged 65 years or older without prior stroke who had linked Medicare claims data. Stroke events in the ARIC and REGARDS studies were identified via active surveillance and adjudicated by expert review. Medicare-linked ARIC data (2016-2018) were used to develop a list of ICD-10 codes for incident stroke detection. The list was validated using Medicare-linked REGARDS data (2016-2019). Data were analyzed from September 1, 2022, through September 30, 2023.ExposuresStroke events detected in Medicare claims vs expert-adjudicated stroke events in the ARIC and REGARDS studies.Main Outcomes and MeasuresThe main outcomes were sensitivity and specificity of incident stroke detection using ICD-10 codes.ResultsIn the ARIC study, there were 110 adjudicated incident stroke events among 5194 participants (mean [SD] age, 80.1 [5.3] years) over a median follow-up of 3.0 (range, 0.003-3.0) years. Most ARIC participants were women (3160 [60.8%]); 993 (19.1%) were Black and 4180 (80.5%) were White. Using the primary diagnosis code on a Medicare billing claim, the ICD-10 code list had a sensitivity of 81.8% (95% CI, 73.3%-88.5%) and a specificity of 99.1% (95% CI, 98.8%-99.3%) to detect incident stroke. Using any diagnosis code on a Medicare billing claim, the sensitivity was 94.5% (95% CI, 88.5%-98.0%) and the specificity was 98.4% (95% CI, 98.0%-98.8%). In the REGARDS study, there were 140 adjudicated incident strokes among 6359 participants (mean [SD] age, 75.8 [7.0] years) over a median follow-up of 4.0 (range, 0-4.0) years. More than half of the REGARDS participants were women (3351 [52.7%]); 1774 (27.9%) were Black and 4585 (72.1%) were White. For the primary diagnosis code, the ICD-10 code list had a sensitivity of 70.7% (95% CI, 63.2%-78.3%) and a specificity of 99.1% (95% CI, 98.9%-99.4%). For any diagnosis code, the ICD-10 code list had a sensitivity of 77.9% (95% CI, 71.0%-84.7%) and a specificity of 98.9% (95% CI, 98.6%-99.2%).Conclusions and RelevanceThese findings suggest that ICD-10 codes could be used to identify incident stroke events in Medicare claims with moderate sensitivity and high specificity.

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How Reliable Are Administrative Data for Capturing Stroke Patients and Their Care

Cited by 65 publications

References 25 publications

Validation of billing code combinations to identify cardiovascular magnetic resonance imaging scans in Ontario, Canada: a retrospective cohort study

Validation of billing code combinations to identify cardiovascular magnetic resonance imaging scans in Ontario, Canada: a retrospective cohort study

Health Services

Derivation and Validation of ICD-10 Codes for Identifying Incident Stroke

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